Dr. M.J. Bazos, MD Patient Handout

CEREBROVASCULAR ACCIDENT
(CVA, STROKE)

About Your Diagnosis

Cerebrovascular disease is the most common cause of neurologic disability in the United States. Most cerebrovascular illnesses are caused by artery disease and high blood pressure, or a combination of both. A “stroke” or CVA may be caused by a partial or complete blockage of a blood vessel supplying part of the brain, and in this case there is generally no bleeding. Or, a stroke may result from a ruptured blood vessel with bleeding in or around the brain.

Living With Your Diagnosis
The symptoms and signs of a stroke reflect the area of brain that is damaged and not necessarily the specific artery that is diseased. The symptoms of a stroke tend to occur abruptly. If it is a bleeding stroke, it may have a catastrophic onset. Symptoms are almost always limited to one side of the body. Strokes may cause facial weaknesses, difficulty with speech, difficulty swallowing, or weakness of the arm and/or leg. The symptoms of a stroke are usually worst in the first 24–72 hours. The neurologic deficit after a stroke may range from mild to debilitating, depending on the area of the brain that is affected; however, the degree that one may recover or adapt often will not be know for months to years. Many individuals who have strokes will require some form of rehabilitation. This may include speech therapy, physical therapy, and occupational therapy.

Treatment
In addition to treating the underlying conditions (high blood pressure, diabetes, tobacco abuse, sedentary lifestyle, and high cholesterol levels), the treatment is aimed at preventing further strokes. For many individuals this will include medications to prevent blood clots from forming in the heart or blood vessels supplying the brain. For others it will mean controlling high blood pressure and reducing their other risk factors for stroke. Depending on the nature and extent of a stroke, you may be treated as an outpatient or inpatient. Often this is as simple as taking a small amount of aspirin each day. However, if you continue to have transient ischemic attacks (TIAs) and/or strokes while on medication, a more potent “blood thinner” may be necessary, which usually requires admission to the hospital. Some TIAs and strokes are caused by plaques or clots in the large arteries of the neck. An ultrasound study of the arteries in your neck may be necessary to determine the probable cause of your symptoms and whether surgery is necessary to remove the blockage. The following are some of the more common symptoms of a TIA or stroke:
• Weakness or numbness on one side of the face or body (face, arm, leg).
• Changes in vision.
• Confusion.
• Dizziness.
• Binocular blindness.
• Double vision.
• Slurred speech, inability to talk, or difficulty swallowing.
• Loss of coordination or balance.
In 70% of cases, the symptoms of a TIA will resolve in less than 10 minutes, and in 90% they will resolve in less than 4 hours. Those deficits that persist beyond 24 hours are regarded as a stroke or CVA. Remember, a TIA is a warning sign that you are at risk for a stroke.

The DOs
• Take note of the conditions and symptoms when you have a TIA: What kind of activity were you doing when it occurred? Exactly what symptoms did you have? How long did your symptoms last? When did they occur?
• Take only the medications prescribed by your doctor. Some of these medications may require you to get blood tests on a regular basis.
• If you have other medical problems, such as diabetes, a high cholesterol level, or high blood pressure, be sure that your physician is aware of those problems and that they are being managed as well.
• Keep your follow-up appointments with your doctor.

The DON’Ts
• Don’t use tobacco products; these promote and accelerate vascular disease, and they will increase your risk of stroke.
• Don’t eat a high-fat diet.
• Don’t use alcohol.
• Avoid driving or doing any activity in which a sudden onset of symptoms described above could put you or others in danger.
• Don’t delay in reporting recurrent symptoms to your doctor.
• Avoid strenuous activities and exertion.

When to Call Your Doctor
• If you have another TIA or stroke after beginning medication.
• If you have an unusually severe headache.
• If you have any problems associated with your medication.

Websites:
http://neuro-www.mgh.harvard.edu/
Robert’s Neurology Listings on the Web
http://mediswww.meds.cwru.edu/dept/neurology/robslist.html
Stroke Connection